Guiding Principles in Providing Integrated Behavioral Health Services for
Young Children and Their Families: The Starting Early Starting Smart
Experience
The SESS Philosophy
The SESS program goals are to develop, evaluate rigorously,
and disseminate new knowledge and information on how best to integrate and provide
behavioral health services (services targeting mental health and substance abuse)
to young children and their caregivers. To accomplish this task, prevention
and treatment services were integrated within settings that already served young
children and their families (child care, Head Start, and Primary Health Care).
The primary SESS guiding principle is captured in the phrase,
"It's all in the relationship." Clinical, collaborative, and administrative
efforts are all relationship-oriented, focusing on positive parent-child, family-staff,
staff-agency, and agency-agency interactions. The success of this work depends
first and foremost upon positive rapport and trust building with families.
The first step in planning a SESS collaborative is a
comprehensive community assessment to obtain a clear demographic picture and
to identify existing community resources. It is recommended that this assessment
be carried out with other organizations such as existing task forces, multidisciplinary
teams, and human service coalitions. Matching services to populations requires
responding to specific documented needs; it does not require replication of
an inflexible program model. There is no single universally implemented SESS
model. Rather, there is a SESS framework which serves as a guide to program
design. The required behavioral health service components are depicted in Exhibit
1.
Families Must Participate as Full Partners
SESS Families, as consumers, are involved in all stages of program
development, including planning, implementation, and evaluation. Because the
quality of the relationship between the family and the service providers is
key to program effectiveness, family involvement is not only an ethical imperative,
but a pragmatic one as well. The family voice requires more than representation,
it requires active participation.
Collaboration—With Other Community Programs That Serve Families—Is Fundamental
To provide the needed comprehensive range of services for SESS
participants, it is imperative that a genuine spirit of cooperation exists among
a range of stakeholders. Examples of collaboration partners include family members,
mental health providers, substance abuse prevention and treatment providers,
early childhood and youth services, educational settings, child welfare agencies,
social service agencies, health care providers, criminal justice agencies, faith-based
service programs, and public health initiatives.
A Culturally Relevant Intervention Approach Is Essential
Families need access to cultural, linguistic, and age-appropriate
services. Families reflect cultural diversity in their values and beliefs as
well as in the views and expectations they have for themselves. Understanding
diversity factors is particularly important in planning SESS program services.
(Exhibit 2) Implementing a SESS service integration program requires the ability
to customize services to meet the unique cultural needs of individual families,
agencies, and communities. Staff, both professional and paraprofessional, should
be culturally competent, and if possible, reflect the demographics of the populations
served.
A Strengths-Based Program Serves Both Families and Staff
The SESS program has a strengths-based focus (as opposed to
the traditional deficit model). Together staff and family identify the family's
strengths as a part of service planning, and the chosen services incorporate
and build on those strengths. The importance of "the relationship" in a strengths-based
approach necessitates attention to how well staff are supported, trained, and
nurtured by the program. Dedication and committment to serving the target population
or community, as well as overall "buy-in" to the general SESS philosophy and
approach are essential to program fidelity.
The SESS "Golden Rule" dictates that agencies treat staff in
the same manner they would like the staff to treat families. This parallel process
of an agency nurturing its staff can significantly affect how staff nurture
families. Staff who feel supported and valued can model ways in which parents
can support and value their children.
Flexibility in Meeting Basic Family Needs Is Critical
One basic key to engaging families in services is to maintain
a flexible schedule of when and how services are provided. Opportunities for
program involvement are made available at various days, times, and convenient
locations (including center- and home-based activities). In addition, SESS programs
address concrete barriers to participation, including basic needs for transportation
and childcare.
Exhibit 1. Behavioral Health Service Components
Exhibit 2.
The SESS Difference
SESS principles draw upon a wealth of intuitive, good-practice
knowledge, which has been developed by parents and professionals over the years.
The important SESS difference is in the outcomes. SESS has been
rigorously evaluated in 12 sites over a 4-year period. Empirical evidence says,
“SESS Works.”
The SESS program and evaluation study are sponsored by
an innovative public-private collaboration between the Federal Substance Abuse
and Mental Health Services Administration (SAMHSA) and Casey Family Programs,
a private operating foundation.
Single copies of SESS publications-which amplify the
principles, practices, and evidence-based outcomes on which this fact sheet
is founded-are available FREE (while supplies last) from the National Clearinghouse
for Alcohol and Drug Information. Call (800) 729-6686 or go to ncadi.samhsa.gov
to preview, download SESS publications, or to order online.
Casey Family Programs
1300 Dexter Avenue, North
Seattle, WA 98109
Washington, DC Office
1808 Eye St, NW
Washington, DC 20006
voice 202-467-4441
fax 202-467-4499
Substance Abuse and
Mental Health Services
Administration
5600 Fishers Lane
Rockwall II, Room 950
Rockville, MD 20857
voice 301-443-7762
fax 301-443-7878
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